Debridement and interbody fusion via posterior pedicle lateral approach for ankylosing spondylitis with thoracolumbar Andersson lesion / 中国修复重建外科杂志

Objective: To investigate the safety and effectiveness of debridement and interbody fusion via posterior pedicle lateral approach in treatment of ankylosing spondylitis with thoracolumbar Andersson lesion (AL). Methods: Between October 2011 and January 2017, 10 patients of ankylosing spondylitis with thoracolumbar AL were treated with debridement via posterior pedicle lateral approach and interbody fusion with bone grafting. There were 8 males and 2 females with an average age of 48.8 years (range, 31-79 years). The disease duration was 1.5-48.0 months (mean, 10.6 months). All patients were single-segment lesion, including 3 cases of T10, 11, 4 cases of T11, 12, and 3 cases of T12, L1. The preoperative visual analogue scale (VAS) score was 8.0±0.8, the Oswestry disability index (ODI) was 68.8%±5.5%, and the Cobb angle of local kyphosis was (26.3±7.1)°. According to American Spinal Injury Association (ASIA) scoring system, neurological impairment was assessed in 1 case of grade C, 4 cases of grade D, and 5 cases of grade E. Results: All the operations of 10 patients completed successfully. The operation time was 120-185 minutes (mean, 151.5 minutes), and the intraoperative blood loss was 300-750 mL (mean, 450.0 mL). Dural sac tear occurred in 1 case during operation and was repaired, with no cerebrospinal fluid leakage after operation. All patients were followed up 24-50 months (mean, 31.2 months). At last follow-up, the VAS score was 1.9±0.9 and ODI was 13.0%±3.0%, showing significant differences when compared with preoperative ones (t=17.530, P=0.000; t=31.890, P=0.000). Neurological function was improved significantly at 24 months after operation, and rated as ASIA grade E. The Cobb angles were (12.6±4.6)° at 3 days and (13.6±4.6)° at 24 months after operation, which were significantly different from those before operation (P0.05). At 24 months after operation, the grafted bone obtained good fusion at AL segment. During the follow-up, there was no failure of internal fixation such as nail withdrawal, broken nail, and broken rod. Conclusion: Debridement and interbody fusion via posterior pedicle lateral approach for the ankylosing spondylitis with thoracolumbar AL can achieve satisfactory effectiveness, good fusion, and a certain correction of local kyphosis.

Andersson lesion in ankylosing spondylitis: a systematic review / 中华风湿病学杂志

Objective To investigate the clinical features of Andersson lesion (AL) in ankylosing spondylitis (AS).Methods A comprehensive search was performed for all scientific literatures using search string "ankylosing spondylitis Andersson lesion vertebral lesion destructive lesion spondylodiscitis" "discitis" "pseudarthrosis" or "stress fracture" published between January 1937 and December 2016.Literature screening and data extraction were done according to the inclusion and exclusion criteria.Statistical Product and Service Solutions (SPSS) 23.0 software was used for statistical analysis.Data was analyzed by one sample t test and paired sample t test.Results Fifteen papers were selected after literature review (57) and 47 cases met the selection criteria fimally.Male patients was 38(81％) and female was 9(19％),and their average age was (45±12) years old.The disease duration was defined as the time range from the definite diagnosis of AS to the onset of AL and it was between 0.5 to 41years with the average of (11±7) years.Twenty-four cases (51％) had a clear history of trau.ma.Twenty cases (43％) performed kyphosis in which thoracolumbar segments (15 cases)was the most commonly involvedand the difference was statistically significant (P＜0.05).Four cases (9％) were misdiagnosed as tuberculosis.There was no statistically different for preoperative and postoperative ESR and CRP (P＞0.05).The above cases were confirmed by imageology (42 cases) and magnetic resonance imaging (MRI) was the best method.Forrty cases (85％) were treated by surgery and the other 7 cases (15％) were treated with immunosuppressive therapy.Conclusion AS patients with AL are always associated with trauma and diagnosed by means of MRI.Orthopedic effect and good fusion can be obtained by pedicle and intervertebral disc osteotomy which is an effective method for the treatment of AS with AL.

Circumferential Fusion through All-Posterior Approach in Andersson Lesion

STUDY DESIGN: Retrospective case series. PURPOSE: To assess safety and efficacy of single stage, posterior stabilisation and anterior cage reconstruction through the transforaminal or lateral extra-cavitary route for Andersson lesions. OVERVIEW OF LITERATURE: Pseudoarthrosis in ankylosing spondylitis (Andersson lesion, AL) can cause progressive kyphosis and neurological deficit. Management involves early recognition and surgical stabilisation in patients with instability. However, the need and safety of anterior reconstruction of the vertebral body defect remains unclear. METHODS: Twenty consecutive patients with AL whom presented with instability back pain and or neurological deficit were managed by single stage posterior approach with long segment pedicle screw fixation and anterior vertebral reconstruction. Radiological evaluation included- the regional kyphotic angle, measurement of anterior defect in computed tomography (CT) scan and the spinal cord status in magnetic resonance imaging. Radiological outcomes were assessed for fusion and kyphosis correction. Functional outcomes were assessed with visual analogue scale (VAS), ankylosing spondylitis quality of life (ASQoL) and Oswestry disability index (ODI). RESULTS: The mean age of the patients was 50.1 years (male, 18; female, 2). The levels affected include thoracolumbar (n=12), lower thoracic (n=5) and lumbar (n=3) regions. The mean level of fixation was 6.2±2.4 vertebrae. The mean anterior column defect was 1.6±0.6 cm. The mean surgical duration, blood loss and hospital stay were 112 minutes, 452 mL and 6.2 days, respectively. The mean followup was 2.1 years. At final follow up, VAS for back pain improved from 8.2 to 2.4 while ODI improved from 62.7 to 18.5 (p <0.05) and ASQoL improved from 14.3±2.08 to 7.90±1.48 (p <0.05). All patients had achieved radiological union at a mean 7.2±4.6 months. The mean regional kyphotic angle was 27° preoperatively, 16.7° postoperatively and 18.1° at the final follow-up. CONCLUSIONS: Posterior stabilisation and anterior reconstruction with cage through an all-posterior approach is safe and can achieve good results in Andersson lesions.

Research progress on Andersson lesion in ankylosing spondylitis / 中华外科杂志

Andersson lesion is a destructive vertebral or disco-vertebral lesion that occurs in the late stage of the ankylosing spondylitis. According to the etiology, these lesions are usually classified into localized lesions and extensive lesions. The history of ankylosing spondylitis and characteristic imaging is the key to the diagnosis of Andersson lesion. Conservative treatment may be effective for localized lesions. However, surgical intervention is often required for the failure of conservative treatment and extensive lesions. Currently, the optimal procedure for this problem is spinal osteotomy through pseudarthrosis and debridement via posterior-only approach.

Espondiloartritis anquilosante: revisión de hallazgos imagenológicos en la columna / Ankylosing spondyloarthritis: review of spinal imaging findings

Abstract: Introduction. Ankylosing spondyloarthritis (AS) is the most common and representative of seronegative spondyloarthropathy. It is characterised by chronic inflammation of the axial skeleton, leading to chronic back pain and progressive stiffness. It typically occurs in young patients, with symptoms often appearing with peak onset between 20 and 30 years of age, and is strongly associated with human leukocyte antigen B-27 (HLA B-27). Current imaging techniques are central in the management of these patients. The recognition of its classic imaging findings and its complications is essential for radiologists. Objectives. To present a pictorial review of the spinal imaging findings in patients with AS. Methods and materials. An analysis will be made of the spinal imaging findings in conventional radiography, CT and MRI in multiple patients from our medical centre. The most representative findings, complications, differential diagnoses, and some radiological key points will be shown.

Resumen: Introducción. La espondilitis anquilosante (EA) es la artropatía seronegativa más común y representativa. Se caracteriza por inflamación crónica del esqueleto axial, dolor referido a la columna vertebral de tipo inflamatorio y rigidez progresiva. Típicamente se manifiesta en pacientes jóvenes que inician su sintomatología entre los 20-30 años de edad y está ligada al antígeno leucocitario humano B-27 (HLA B-27). Las imágenes son fundamentales en el manejo de estos pacientes. Es deber del radiólogo reconocer los hallazgos imagenológicos presentes. Objetivos. Realizar una revisión pictográfica de hallazgos imagenológicos presentes en la columna vertebral de pacientes portadores de EA. Material y método. Análisis de las manifestaciones imagenológicas de columna más representativas de la EA en pacientes de nuestro centro en radiografía convencional, TC y RM, junto con posibles complicaciones y diagnósticos diferenciales.

Andersson Lesion in Ankylosing Spondylitis

Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosing spondylitis. We report three cases of ankylosing spondylitis with such lesions. These lesions simulate an infection and in our country, mimic spinal tuberculosis.